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Pertussis outbreaks hit west, midwest – again

Once again, parents’ irrational refusals to vaccinate are singled out as the major contributor of the outbreak. Outbreaks of pertussis are again hitting multiple parts of the country, with Montana, Washington and Wisconsin all reporting significant increases in the number of cases of whooping cough.

As of May 19, for example, the Washington State Department of Health had reported a total of 1,738 cases throughout the state. By the same date in 2011, Washington had reported only 148 cases. The current figures put the state on track to have the highest number of reported cases in decades.

In April, Washington Secretary of Health Mary Selecky stated that pertussis had reached epidemic levels in the state, and she called for all eligible children and adults to be vaccinated against the disease.

Specifically, she said that children ages 7-10 years who are not fully vaccinated should complete the diphtheria and tetanus toxoids and acellular pertussis (DTaP) vaccine series, and those age 11 or older should receive a tetanus and diphtheria toxoids and acellular pertussis (Tdap) booster.

Washington Gov. Chris Gregoire also got into the act, announcing in a May 3 news release that the state had received CDC approval to use federal funds designated for other immunizations to buy more than 27,000 doses of pertussis vaccine for uninsured and underinsured adults. In addition, she announced that the state would use $210,000 in existing health department funds, plus another $90,000 in emergency funds, “to strengthen public awareness efforts about the need for vaccination.”

According to Michele Roberts, health promotion and communications section manager for the Washington State Department of Health Immunization and Child Profile Office, the state has one of the highest percentages of parents in the nation who choose to opt out of having their children immunized. In 2011, she said, roughly 6 percent of kindergartners in the state missed one of the required immunizations because a parent chose not to vaccinate.

Long an outspoken advocate of immunization, the AAFP partnered with the CDC and American Academy of Pediatrics in 2010 to offer Provider Resources for Vaccine Conversations with Parents and, more recently, first-person parental accounts that detail the toll pertussis can take on infants. All are intended to help physicians reassure parents who have concerns about their child’s vaccines.

In addition, the AAFP has adopted provisional recommendations for the use of Tdap vaccine that are consistent with those developed by the CDC’s Advisory Committee on Immunization Practices (ACIP) and that are intended to stop the spread of disease to young patients who cannot yet receive the vaccine. Among those provisional recommendations are the following:

adults ages 19 and older who have not received a dose of Tdap vaccine should receive a single dose of the vaccine;

Tdap vaccine should be administered regardless of the interval since administration of the last tetanus or diphtheria toxoid-containing vaccine; and

adults should receive a Tdap dose if the dose is recommended and no record of previous administration exists.

The ACIP’s provisional recommendations also account for the fact that two Tdap products are available in the U.S. market. They are GlaxoSmithKline’s Boostrix, which is approved for use in people ages 10 years and older, and Sanofi Pasteur’s Adacel, which is approved for use in patients, ages 11-64. Specifically, the recommendations state that vaccine providers should not miss an opportunity to vaccinate eligible patients ages 65 and older and may administer whatever vaccine they have available; and when feasible, Boostrix should be used for adults ages 65 and older, although either vaccine product administered to a person in this age group provides protection and is considered valid.